Are we ready for MERS?

Sunday

Jun 8, 2014 at 2:00 AM

PORTSMOUTH — At least two cases of Middle Eastern Respiratory Syndrome, or MERS, a very dangerous virus, have been seen in the United States and health care workers are readying themselves in the event more cases emerge.

Karen Dandurant

PORTSMOUTH — At least two cases of Middle Eastern Respiratory Syndrome, or MERS, a very dangerous virus, have been seen in the United States and health care workers are readying themselves in the event more cases emerge.

According to the Centers for Disease Control, MERS is a dangerous coronavirus first reported in Saudi Arabia in 2012. It is a severe, acute respiratory illness categorized by fever, cough and shortness of breath. Of the confirmed cases of MERS, 30 percent of the patients have died.

The disease is mainly contained to Middle Eastern countries at this point, though cases have reached European countries and two reported cases were confirmed in the United States.

Both of the U.S. cases have been identified as being in persons who were traveling to this country from Saudi Arabia. The first case was reported to the CDC on May 2, a person in Indiana. The second was reported May 11 in a patient in Florida.

"The first thing we will look at if we suspect a case is the person's travel history because that seems to be a key factor," said Dr. Kristin Lee, an infectious disease specialist for Core Physicians. "I would say the general population does not have to be too concerned at this point. The risk is coming into play with people who have been traveling in the Middle East, or who were exposed to someone who was there."

That being said, health care workers are readying themselves. Lee said hospitals are having a series of conference calls with the Department of Health, to be kept apprised of the situation as it develops and to put protocols in place as needed.

Chris Adamski, bureau chief for Infectious Disease at the New Hampshire Department of Health and Human Services, said state health officials are aware of the potential for transmission and are watching carefully, as are health officials across the globe.

"We have good clinical guidelines in place for this, as with any potential epidemic that might occur," Adamski said. "We are looking at readiness control. If there is a suspected case, we will implement all the necessary infection control, including the use of personal protective equipment and isolation of patients until we are sure of what we are dealing with."

Lee said what is known at this point is that the virus is transmitted person to person. The method of transmission is less clearly understood and that is what health care officials are trying to determine.

"There have been 572 cases worldwide, with a 30 percent death rate," Lee said. "Up to 60 percent of cases are overseas travelers. Many of the other cases have been hospital acquired. At this point, we are not sure if the transmission is droplet related or airborne. Obviously, if it's airborne there is a much higher rate of concern. MERS is a serious illness and, so far, difficult to understand. Unlike most flu or respiratory ailments, this does not seem to primarily target the elderly or the very young. It spans all age groups."

While the 30 percent mortality rate is alarming, Adamski said there may be unreported cases where people did not get as sick, or the deaths may include people with other co-morbidity that led to their having weakened immune systems.

"There is still a lot we do not know regarding the transmission of MERS," Adamski said. "We suspect respiratory, meaning coughing or sneezing, transmits droplets. We also do not think the virus is too easily transmitted."

Lee said if a case of MERS is suspected, the first priority will be to isolate the patient.

"The symptoms are flu-like, with fever, cough and shortness of breath," Lee said. "It can also have some gastric components. We are advising taking the travel history immediately and if there is any indication the person has been overseas in that area, put a mask on the patient immediately. They will be isolated in a negative pressure room to reduce the risk of spreading the virus. We will conduct blood tests and take throat, nasal and fluid samples."

Because of the unknowns, Lee said local labs are being told not to try to culture the samples themselves, but to send them to the state instead.

"Still, even if you have just come back from Jordan or another Middle Eastern country and you do not feel well, please do not immediately assume this is what you have," Lee said. "There are so many other more common ailments you may have picked up."

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